Spire Portsmouth Hospital

Spire Portsmouth Hospital is purpose built and opened 1984, part of Spire Healthcare Limited hospital network. It is a private hospital providing a range of surgical and medical services for outpatient, day case and inpatients. Services are provided to private and NHS patients aged 18 years and over.

The hospital currently operates 50 beds used flexibly for inpatients and day care across two wards, a single bedded room can be equipped for enhanced monitoring. There is no critical care facility or emergency department at the hospital. The first floor ward has four oncology day care pods and a treatment room for day case chemotherapy.

The on-site facilities include an endoscopy suite, three operating theatres (two with laminar airflow) an outpatient department and diagnostic imaging department offering plain X-ray, ultrasound, mammography, MRI and CT scans. Physiotherapy treatment is offered as an inpatient and outpatient service in its own physiotherapy suite of gym and treatment areas. There is an accredited sterile services department and pathology laboratory on site.

Services offered include general surgery, orthopaedics, cosmetic surgery, refractive eye surgery, gynaecology, ophthalmology, oral & maxillofacial surgery, general medicine, oncology, dermatology, physiotherapy, endoscopy and diagnostic imaging. Orthopaedic services are available to NHS patients through Choose and Book.

We inspected the hospital as part of our planned inspection programme, visiting 13-14 April 2016 followed by an unannounced visit 28 April 2016. This was a comprehensive inspection and we looked at the three core services provided by the hospital: medicine, surgery, and outpatients and diagnostic imaging.

The hospital was rated as ‘good’ overall.. All services were rated good overall, with safety requiring improvement in surgical, and outpatient and diagnostic imaging services. .

Our key findings were as follows:

Are services safe at this hospital?

By safe, we mean people are protected from abuse and avoidable harm.

• We had concerns that the layout and some practices in the operating theatre department did not fully protect patients from the risk of hospital acquired infections. At the time of the inspection the hospital did not follow national guidance recommendations that for surgery carried out under Ultra Clean Ventilation (UCV) systems, the equipment should be prepared under the same conditions.

• In diagnostic imaging a member of staff who was not an authorised health professional under the legislation relating to Patient Group Directions (PGD), had been permitted to issue two contrast media products via PGD. When we brought this to the attention of the radiology manager, this practice was ceased immediately.

• In all other respects medicines were stored securely and managed safely. Pharmacy staff were actively involved in the pre-admission, admission, inpatient and discharge processes.

• Staff reported incidents and openness about safety was encouraged. Incidents were monitored and reviewed and staff clearly demonstrated examples of learning from these. Senior management understood and adhered to the Duty of Candour appropriately

• Clinical areas were visibly clean and tidy. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections.

• Staff received appropriate training to perform their role safely, were supported to keep their skills up-to-date. The hospital set a target of 95% compliance with mandatory training. The compliance rate overall for 2015 was at 84% with some training such as information governance on target at 95%.

• Staff were knowledgeable about the hospital’s safeguarding policy and clear about their responsibilities to report concerns.

• Equipment was safety tested and well maintained, in line with manufacturer’s guidance. The estates and engineering department had excellent systems, processes and procedures for ensuring appropriate monitoring and maintenance, and decontamination, of equipment across the hospital.

• Records were managed safely, securely stored on site and available when needed. Processes were in place to reduce risks to private patient records taken off site by consultant secretaries.

• Staff routinely assessed and monitored risks to patients. There were appropriate transfer arrangements to transfer patients to a local NHS hospital if required.

• Staffing levels and skills mix were planned, implemented and reviewed to keep patient’s safe at all times.

• Plans and arrangements were in place to respond to emergency situations.

Are services effective at this hospital?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence..

• Patients care and treatment was planned and delivered in line with current evidence based guidance, best practice and legislation.

• Endoscopy staff took account of National Institute for Health and Care Excellence (NICE) guidance, but work was ongoing to achieve Joint Advisory Group (JAG) on gastrointestinal endoscopy accreditation.

• Patient outcome data was reported for comparative analysis for surgical services, but outcomes following endoscopy procedures were not monitored at the hospital. The hospital was introducing an electronic system April 2016, to capture outcome data following a procedure.

• The hospital took part, and performed in line with England average, in national audits to measure outcomes for NHS patients undergoing joint replacement surgery.

• Oncology patient outcomes were monitored at cancer multi-disciplinary (MDT) meetings and work was ongoing to ensure 100% of notes of MDT meetings were available at the hospital

• Staff worked well within teams and across different services to plan and deliver patients’ care and treatment in a coordinated way.

• Staff were supported in their role through appraisals. All staff were appraised or had appraisals booked with their managers. Staff were encouraged to participate in training and development to support them to deliver good quality care.

• The hospital had a process for checking competency and granting and reviewing practising privileges for consultants. The medical advisory committee (MAC) reviewed patient outcomes and the renewal of practising privileges of individual consultants. It also reviewed policies and guidance and advised on effective care and treatments.

• Communication between Medical Advisory Committee (MAC) Chair and the local trust medical directors was maintained to ensure a coordinated approach to consultant engagement. Consultant concerns were discussed by the hospital management team with the MAC Chair, and if considered serious enough, with the Spire Medical Director.

• Radiology staff were aware of competencies of consultants for procedures and use of equipment. Senior staff in outpatient department (OPD) were informed of the competencies or any restrictions on practice for individual consultants by the senior management team if issues arose.

• Patients’ pain needs were met appropriately during and following a procedure or investigation.

• The consent process for patients was well structured and included consent for anaesthesia. Although rarely used in practice, staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

• The hospital offered a choice of meals and drinks and the chef catered for patients requiring special diets. The Patient Led Assessment of the Care Environment (PLACE) in 2015 rated the quality of ward food as 100%, higher than the England average 94%.

Are services caring at this hospital?

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

• During the inspection, we saw that staff were caring, sensitive to the needs of patients, and compassionate. Staff maintained patients’ dignity and respect at all times.

• Patients commented positively about the care provided by all staff and said they were treated courteously and respectfully.

• Patients told us they had sufficient information about their treatment and were involved in making decisions about their care.

• The hospital patient satisfaction survey showed a rating of 93% against the average provider group score of 92% for ‘discussing patient care and treatment plans.’

• Staff supported patients emotionally with their care and treatment as needed.

• Hospital performance data January 2016 to March 2016 showed care and attention from the nurses score as 99%.

Are services responsive at this hospital?

By responsive, we mean that services are organised so they meet people’s needs.

• Services were planned and delivered in way which met the needs of the local population. Patients told us that there was good access to appointments and at times which suited their needs.

• Facilities and premises were appropriate for the services being delivered.

• Waiting times, delays, and cancellations were minimal and managed appropriately. Physiotherapy and diagnostic imaging appointments were on time and patients were generally kept informed of any delays in outpatient clinics

• The hospital met the referral to treatment time targets for NHS patients.

• Staff assessed patient’s needs before admission, and the hospital was able to take the needs of different people into account when planning and delivering services. For example, suitably trained staff ensured the hospital met the needs of patients living with dementia or a learning disability.

• Patient Led Assessments of the Care Environment (PLACE) for February to June 2015 showed the hospital scored 88% for dementia which was higher than the England average of 81%.

• Staff took account of individual patient’s spiritual, religious and emotional needs when delivering care and treatment.

• There was patient information on specific procedures, conditions and hospital charges. This was in English with other languages or formats , such as braille, available on request. The hospital reported that they had minimal numbers of patients who could not understand English. For those patients, they had good access to translation service, when needed.

• The hospital dealt with complaints and concerns promptly, and there was evidence that the hospital used learning from complaints to improve the quality of care.

Are services well led at this hospital?

By well led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovations and promotes an open and fair culture.

• There was a clear statement of goals and a local strategy with a strong focus on continuous learning and improvement across the hospital. This aligned with the corporate vision and mission for excellence and highest quality patient care.

• Staff knew and understood the hospital vision and strategic goals and how that aligned with their services. Staff and senior managers were committed to, and demonstrated, the organisational values in their day to day work.

• There was a clear governance framework to monitor quality, performance and risk at department, hospital and corporate level. Staff leads attended governance meetings and committees. Staff received feedback from hospital-wide meetings in emails and through team meetings and minutes.

• Quality and safety of care was regularly discussed in senior management team meetings, and in other relevant meetings below that level. The Spire Healthcare Clinical Scorecard, covered a range of quality and safety information for hospitals across the organisation. This was used by the hospital as a focus for local improvement and benchmarking against other hospitals. The hospital was investing in training for the newly appointed governance lead and was committed to improving root cause analysis and learning from incidents

• There was a hospital- wide risk register which incorporated departmental risks which may affect staff, patients and visitors. Staff were able to escalate concerns and the risk registers reflected the actions to be taken to mitigate risks.

• The Medical Advisory Committee (MAC) met quarterly. The MAC had standing agenda items, which included a quarterly clinical governance report, incidents and complaints, quality assurance, practicing privileges and proposed new clinical services and techniques.

• All policies were approved at corporate and local level. Staff had access to policies in hard copy and on the intranet.

• Staff enjoyed working at the hospital. They described an open culture and felt supported by their management. They were extremely complimentary about their managers and positive about the recent changes in management at the hospital. They told us the leadership team were visible, accessible and approachable. They felt concerns were listened to and where possible acted upon.

• Consultants we spoke with were positive about senior members of the hospital and described good working relationships.

• Patients were encouraged to leave feedback about their experience by the use of a patient satisfaction questionnaire and for NHS patients by the Friends and Family Test. During 2015 the hospital reported consistently high levels (between 98% and 100%) of patients would recommend the hospital to their friends and families. The hospital patient satisfaction survey results showed improvement although overall just below target in net scores for 2015, there were clear action plans for further improvements based on patient feedback.

There were areas where the provider needs to make improvements.

Importantly, the provider must ensure:

• The door from theatre 1 and theatre 2 into the shared preparation room cannot be opened at the same time.

• Assessments of all risks associated with practices in theatres are carried out in a timely manner and actions to mitigate any identified risks are recorded, monitored and regularly reviewed.

In addition the provider should ensure:

• Action taken to mitigate any identified risks in theatre practices should take into consideration national guidance and recommendations.

• Incidents should be appropriately graded and investigations should follow best practice in root cause analysis.

• The hospital should ensure continued progress of action plan to achieve Joint Advisory Guidance accreditation in gastrointestinal endoscopy.

• There should be continued work to have a copy of oncology patients MDT notes 100% of the time.

• The hospital should ensure compliance with all mandatory training to meet hospital target of 95%.

• All staff should receive feedback on complaints from patients.

• There should be more monitoring of outpatient clinics to identify any improvements.

Professor Sir Mike Richards

Chief Inspector of Hospitals